An angry old farts paranoid ramblings

I`m angry. REALLY angry. I`m sick of it all. I read today that Leon Elcock and Hamza Lyzai had been released six months and one year ago respectively, meaning they had both served around two years for the killing of Ekram Haque. Two years. Two fucking years.

Mr. Haque, a 67-year-old retired care worker was killed during a “happy slapping” attack as he left a mosque in Tooting, in front of his three-year-old granddaughter, Marian. CCTV showed them running away laughing after the attack. They were originally charged with murder, but guilty pleas to the lesser charges of manslaughter and assault causing actual bodily harm were accepted by prosecutors.Elcock was 16 at the time, Lysai 15. At the time of the killing, Elcock was on bail for an attack on a couple in their `70s, Jushbhai and Jasumati Patel. Mr.Patel was left with a heel mark on his chest.

On the night Mr.Haque was attacked, Lyzai injured a finger climbing a wall and went to St George’s Hospital, where it was amputated. Hospital CCTV footage showed them dancing and laughing as Mr.Haque lay in another ward, fighting for his life. Three fellow gang members went to see their friend, but when a nurse denied them admission a 12-year-old boy threatened to stab her.

Barrister Michael Wood, for Elcock — suspended from school after a violent attack on a teacher — said the defendant had written a note to the Haque family expressing remorse.

Nigel Lambert, for Lyzai, said his client had become involved in “a few short moments of madness”.

Oliver Blunt, representing a third gang member who could not be named, added: “They were young bored listless youths who sought entertainment in this extremely unpleasant and distorted fashion.”

They were bored, but now remorseful…..Is that supposed to make a difference?

The judge, Martin Stephens, said his powers of sentence in relation to the assaults were “very limited” because of the defendants’ ages, although he did lift restrictions on naming them as a warning to others “who may be tempted to indulge in such appalling behaviour”.

In August 2010, the Attorney General, Dominic Grieve QC MP, decided not to refer the sentences to the Court of Appeal as unduly lenient, `after a very careful review of the case`.

…and what makes it worse?

His family were`nt even told that the two snivelling, pieces of shit scumbags had been released…..

I quote the words of his daughter, Jasmine.

`“I didn’t go to court throughout the trial. I couldn’t face witnessing those two, sitting there as though they didn’t care, then witness the pathetic sentencing. People get longer in jail for tax evasion. Dad’s murder feels like yesterday. We are still in shock. We never believed the initial sentence was long enough. It’s not like they ever showed any remorse. …..“I feel incredibly let down by the justice system. Why should his killers be allowed to live alongside me and others after what they’ve done?`

Are they remorseful? Will they now be plagued with guilt and go on to live to lead more fruitful lives? Look at their eyes, will they bollocks.

I`m angry. Really angry. Figures out recently showed the annual number of new applications to take children into care has passed the 10,000 mark for the first time, when councils in England launched 886 legal proceedings to remove at-risk youngsters from their families in March. This `proves` that councils and social workers are doing their utmost to protect children. Really? Here`s one such case….

A consultation last year about a mild bout of depression with a locum GP at Chartfield Surgery where former Wandsworth councillor Lucy Allan had been registered for 16 years was meant to be routine. She was seen by a newly qualified locum, Katherine Mawer, who told her that she was going to refer her son to social services to see if he needed support. Miss Allen offered to bring her son to see her regular GP but this was refused. She also refused Miss Allan`s request to see another doctor. Miss Allan left telephone messages for two days requesting to speak to another doctor.

The locums subsequent actions were later described by one of her colleagues as a mixture of `good intentions and panic`.

Did the new GP confer with one of the other GP`s in the practice for advice? erm…no.

Unknown to Miss Allan, the locum telephoned Dr Peter Green who was Head of Safeguarding Children in Wandsworth. Dr. Green told her that `if she had concerns she should make them extremely robust in order to justify breaching patient confidentiality.`

….Extremely robust`? or to put it another way…exaggerate and lie…but I digress…

Miss Allan says, ‘The well meaning, cautious, young locum set about following Dr Green’s advice. Over a period of two days, she wrote up increasingly more extreme accounts of our 10 minute consultation. Where I had said my son would know how I would feel because we were close she wrote: “she tells her son frequently she wants to die.” I had said, when asked, that I could never take my life because I could not leave my son behind, she wrote: “if she were to kill herself she would take her son with her.” She did not check her account with me at or tell me of her concerns – she later claimed (on the advice of Dr Green and the Medical Defence Union) that to tell me of the allegations would have put our son’s life at risk.

Catch 22 anyone?

Dr Mawer’s report account was sent to Wandsworth Council and Wandsworth NHS (where Miss Allan was a Non Executive Director). Later the allegations were sent to her son’s school. Miss Allan and her husband were not told what the allegations were, they had no opportunity to challenge them. She was given a full psychiatric assessment by an NHS consultant who said she was mildly depressed and no risk to anyone including her son.

Nevertheless, the police were informed by which point Miss Allan and her husband realised something was seriously wrong. They say that Wandsworth Council refused to accept the evidence of Dr Lebus at Chartfield Surgery who is the Senior Partner responsible for child safeguarding and who had said her son was not at risk. She also says that her son’s school had confirmed he was happy and thriving.

Miss Allan said, ‘Wandsworth would not be deterred; they were on a grim mission to prove emotional abuse of our son – the cause we found out later was my alleged severe mental illness (despite going about my life and work as I always had) and my husband’s alleged inability to protect our son from risk of harm. No one at all met my husband, social workers didn’t interview him – had they done so they would have found a loving reliable hands on dad involved in every aspect of his son’s life.

‘Wandsworth Council even relied on an anonymous consultation with an ‘expert’ I had never met. The evidence that demonstrated our son’s safety and well being was relegated to irrelevant – it was almost as if social workers believed there was a conspiracy of silence by everyone who had met us or knew us.’

Indeed. Consider one Dr. George Hibbert, accused in Parliament of being little more than a ‘hired gun’ for local authorities trying to take children into care, and now facing a GMC inquiry following accusations that he deliberately misdiagnosed parents as having mental disorders to allow social services to take their children into care….but I digress again…

The investigation that ensued was protracted and traumatic for the family and ironically led to a severe depressive disorder for Miss Allan which she had to seek private treatment for due to fears that asking for medical help through the NHS may have been used in evidence against her.

She says, ‘We did not lose our son, but others in similar circumstances do because they do not have access to solicitors, private health and cannot speak out for themselves. There is an assumption of guilt. No one wants to help or support an accused “child abuser.” Being wrongly accused of abusing your child publicly is an horrific accusation for any parent. Social Services seemed entirely unaware of the harmful impact of their actions on families. There is no redress. No apology was received despite an external complaints procedure recommending we should receive one.’

She believes that the system is being overwhelmed by well-meaning social workers convinced of every parents’ guilt but missing out on real cases of child abuse like Baby P and Victoria Climbie.

…Indeed. `Lessons have been learnt`….and in this (and in hundreds of other similar cases), the lesson is `Cover your Arse`

A spokesman for Wandsworth Council said: “If a GP refers child protection concerns to us, we have a duty to investigate and would be rightly criticised if we did not. We completed our investigation in this case and concluded no intervention was required. We refute these claims but in the interests of this family’s privacy, we will be making no further comment.

Well…thats good of them. Or to put it another way….`We didn`t do our job properly, but we`re admitting nothing`

Now, I admit that many, many children need to be taken into care, and likewise, there are countless people who should never, ever be allowed to have children, but surely that means social workers should be doing their damn jobs properly, or am I missing something?

A week or so ago, around midnight, I had been filming in Trafalgar Square. Nothing special, just a few crowd shots, so it was finished fairly quickly, and finished around one am. Despite it being Thursday night, there were crowds of drunks, tourists, home-grown revellers and even a few `ladies` who had stepped out of LiliyWhites (and no doubt hoping to step into The Only Way Is Essex). Walking through Leicester Square, I could see coming towards me a largish (8 – 10) group of policemen. Walking slightly ahead of me were 3 lads in their late teens/early 20`s, and ahead of them were 2 lads of the same age walking towards me.

As the two groups of youths met, I, under the pretext of lighting a cigarette and, being nosey, wanting to know what was going on, listened to their conversation.

`Fecking barstewards`

`Whats going on?`

`Dunno…cnuts`

`What are they doing?`

`Just walking…fecking hate `em…wankers`

`Yeah…they`re all cnuts…they`ll just nick you for anything`.

`Cnuts, all of them`

And with that, they all went on their way. I, however, was now desperate to find a toilet, which, considering the amount of people around, and venues open, were noticeable by their absence.

It is important at this point to mention how I was dressed. Along with the long hair and beard, I was wearing old trainers, faded jeans, a T-shirt and (probably my favourite item of clothing) an old RAF greatcoat. Now, I`m well aware of the reaction that my appearance sometimes engenders. Wearing that coat (and even more so when I`m wearing a leather jacket), I sometimes get sneers, looks of disdain or contempt and often a smile. Not the `Hello, good to see you,how are you?` smile…more the `Hello, I`m harmless, please don`t hurt me` half-smile. Over the years, I`ve been a hippy, greaser, biker, goth, and I accept that some people will judge me on how I look. But I choose to look this way, and I accept the consequences of that choice. Now, I`m not an aggressive person, I`m certainly not an alpha male, and I`m not a junkie….but….. some people will think I am.

But to return to the story. I walked up to one of the cops and asked for directions to the nearest loo. He thought for a second, and then directed me to either a station nearby, or a McDonalds further down the road. He then complimented me on my coat, and remarked that he wished he had something similar for the cold nights.

And that was it. A 30 second conversation. (I didn`t find out why there was a large body of police in that area. Nor did I find out the purpose of the nearby `tent` with two cops outside), but I digress.

My point is………..?

Those youths saw a `bunch of cnuts`…and acted accordingly. I saw a group of policemen, doing their job, and acted accordingly.

Sophie Khan tweeted that `Met police are racist, BNP scum`, and describes herself as a `Solicitor-advocate specialising in Actions against the Police` Since her original tweet, police and members of the public, have responded angrily, which has led to her using the retorts as `proof` that the police are biased against her.

Melanie Strickland, a solicitor and legal observer stated in an open letter following the Occupy London evictions, ` We believe that a number of assaults may have taken place at St Paul’s on the night of the eviction, both by police and by the High Court Enforcement Officers who were being supervised by police at all times. In the latter case, we observed that police allowed High Court Enforcement Officers to assault activists and facilitated these assaults`…and yet one of the evictees stated afterwards… `That’s what they come here to do. It has been peaceful.`

The family of Kester David now allege that the Met police were racist in the investigation of his death, with claims the Met failed to investigate the case thoroughly because the victim and his family are black. Why? Why racist?….Why not `the Met didn`t do their job properly`? The coroner returned an open verdict after a forensic expert said he could not rule out the involvement of someone else in his death. So where is the racism?

Are some cops racist? Very probably. Are some cops fat and lazy? Undoubtedly. Are some cops incompetent? Quite possibly. But there are racist shopkeepers, homophobic plumbers, fat and lazy tailors, incompetent doctors. But for some reason, its only the police who are `institutionally racist`…a throw-away phrase I hate, by the way. Some say it because they believe it to be true. And why do they believe it to be true?…Because people say it….and the more its said, the more `true` it becomes. But perceptions aren`t truth.

Someone (I can`t remember who) once said something along the lines of ` Everywhere you look, you find what you expect`. Maybe, just maybe, sometimes people should look in the mirror, self-reflect, before they make a statement. Maybe they will find the basis of those perceptions.

And maybe remember the Golden Rule `Do as you would be done by`

Oh, and just a thought….Isn`t it strange that these negative stories are suddenly appearing at the same time that the government is trying to rush through fundemental changes to police pay, terms and conditions BEFORE the olympics. This could not be some deliberate strategy I suppose??

I`ve been involved in a few minor incidents in the past week. All small things, all fairly trivial….but they all have one thing linking them. I`ll come to the link later, but first….the Post Office.

I`d watched the Post Office van pull up, watched the driver come to my door, then drive away again. I`d been waiting for a parcel you see, and the sender had promised I`d receive it today. But….no parcel. Some hours later, I checked the mailbox…and there was a card the driver had left…`You were out, blah blah`.So, slightly peeved, I walked the mile to the collections office….and there it began.

4 or so months ago, I went to see my GP. Unfortunately, she was away. so I had to see another doctor at the practice. Things didn`t go well from the start. He asked me about my chest pain, and if the tablets were working.

`I don`t have chest pain, and I`m certainly not on any tablets for it.` He looked puzzled, and asked me if I still had bouts of dizziness. `No-o-o, I said, `I`m not suffering from dizziness.`

He tapped on his computer, scrolled through various screens, and asked me about my medications `Interferon, ribavirin and Citalopram` I said. `There`s nothing on here about those, he said`

I looked at his computer screen. `Ermmm…my name isn`t Ayodele Onyejekwe…and I wasn`t born in 1934` He`d got the wrong patients notes on the screen. He just laughed…I had a sinking feeling and swore, silently, before explaining why I, A.Sabrewulfe, was there. Eembarrassing as it is, I was starting to develop the symptoms of a hyper-active bladder, ie, when I wanted to go…I HAD to go…immediately, if you see what I mean. (I`m trying to be delicate here) He gives me a urine pot, a request for some blood tests, and tells me to go the hospital and come back in a weeks time for the results. A week later, I came to see him again. `Good news`, he tells me `You`re not diabetic`

`I know I`m not,` I said `but what about my bladder?` `Oh, are you having problems with your bladder?` he asked

I told him I was fine, and left.

That was 4 months ago. A month ago, the practice rang me. Evidently the same GP wanted me to repeat the blood test. For Diabetes. I explained that I didn`t HAVE diabetes. `I know, said the receptionist,`but the doctor wants to confirm that you still don`t`. I couldn`t help myself. I pointed out that I also didn`t have Lassa Fever, Rabies or Tuberculosis, so maybe I should be tested to confirm I didn`t have them either. There was a long pause.`So shall I send you the forms, or will you come in and collect them?`

Two weeks ago, I went to see my own GP about the bladder problem. Now, I won`t have a word said against her. She`s one of the best GP`s I`ve ever had. So I didn`t mind when she gave me a urine pot a blood test request form, and told me to make an appointment to see one of the male GP`s, `just to check my prostate`.

Eeep.

So I went to the receptionist, and asked for an appointment with one of the males.

`OK,the doctor`s list is full today, so if you could ring at 8.30 tomorrow morning……`

`But, I said, your sign says I can make an appointment for tomorrow`

`Yes, you can make an appointment for today, next day or next week.`

OK, I`d like to make an appointment now, for tomorrow`

`Yes, she patiently explained` If you could ring tomorrow morning….`

You just said I can make an appointment for `next-day`. Oh forget it. Can I make an appointment for next week, please?`

`Yes`, she said` Just ring at 8.3 on the day you want to come and…...`

I gave up. There was no point in arguing, It was painfully obvious that I wasn`t going to win.

`Is there anything else I can help you with?` she asked.

Which brings me to the Hospital, and the bus ride there..

It was early, and the bus was packed. Luckily, I`d managed to get a seat near the front of the bus, so I had a clear view of the woman who later got on with a child in a buggy. But there was a problem. Evidently she didn`t have enough on her Oyster card. She rummaged through her purse, but was 10p short. She did have a £20 note, but the driver wouldn`t accept it, he `wasn`t allowed` to give that much change. She asked if she could just pay the £2.20 she had, `it was only 10p short`…the bus driver ordered her off. I gave her the 10p, and finally the bus moved.

At the hospital out-patients, I took my ticket and vainly looked for a seat. They had changed the system. In the `old days`, you tore a ticket off the roll on the wall and waited for a pre-recorded voice to call your number, and in you went. Now, you pushed a button on a shiny box on the wall, the ticket (same style, colour, print) is issued and you wait for a pre-recorded voice to call your number, PLUS, the number is shown on a new, shiny monitor, along with the `estimated waiting time`. There were 98 people in front of me. The monitor told me that there was `currently a waiting time of 28 minutes….` After an hour, with still 52 people in front of me, I went and spoke to one of the staff. I showed her my professional ID and suggested that they gave me the requisite vials, and I would take my own blood. She didn`t think that was allowed, asked me to take a (non-existent) seat…as`It won`t be long now` I pointed out that the hospital were quite happy with me injecting myself every 7 days…so what was the difference? Thy would have one less `client` (or is it customer… service user, maybe?) and I could get away quicker. Win-win situation, I thought. She blinked, then asked me to take a seat before rushing off. I finally left out-patients at 11.35. I had entered at 09.15. Two hours and twenty minutes…just for a blood-test.

And that’s it. Various small incidents in my life over the last few months. And what, Dear Reader, links them?…apart from me, obviously.

It’s this. They all had a little sign or notice on the wall. Sometimes with different words, but all saying the same thing……`Aggressive behaviour will not be tolerated`

But that’s not what it’s saying at all. What it’s really saying is…..

`We will give you a sloppy, 3rd-rate service. You will wait in line for hours. You will fill in unnecessary forms, be treated like a child, sneered at, and be treated with disdain. We will deal with you in an, at most, cursory manner and we will consider you to be an intrusion into our lives. You will accept all this, without a word of complaint, or we will withdraw our service completely. Now shut up and do as you`re told`

Now, I`m not an idiot. Sometimes there`s breakdowns in communication, or a mistake is made, things take longer than expected. At those times, a simple `Sorry`, with a quick explanation of why things have changed, and all is fine (usually). But these notices aren`t that. The implication is that the public WILL get angry…. And WHY would you expect the public to get angry? Because of the piss-poor service, maybe?

Well, I`ve had enough. I`m going to get some cards printed, with just few lies of text. It will read

`I expect an adequate level of service. I expect to get the service that I paid for. I expect to be treated as an intelligent human being. If you treat me as anything less, I reserve the right to lean over the counter and smack you in the mouth. Your co-operation is appreciated`

Its been a while since I last wrote to this blog. There`s a list of reasons why; Firstly my health, then a couple of bouts of depression, writing other things (Yes, I`m stll writing my book, No, I`m nowhere near finished), and my new fledgling career as an extra, all coupled with a general despair at the government, and the way this country is headed. I ended up either too angry, or too depressed, to even contemplate writing. And then, yesterday, something happened. Something so incomprehensibe, so alien to me, thatI had to write about it. And what was this catalysmic event? A UFO landing, perhaps?…mounted police baton-charging the local Women`s Institute, maybe?….the local hospital eing discovered as a front for a large-scale, international black-market organ bank?…nope, it was in fact, Dear Reader, two teenagers on the bus…..

My wife and I were on our way home from the doctors at the time, her engrossed in her kindle, me just looking idly out the window, people-watching, when two plastic gangsters got on, one wearing a beanie, one swathed in cheap gold chains. Being together, this thereore necessitated one sitting on the seat in front of us, while the other sat in the seat to the left of us, both sitting at a 45 degree angle, one leg outstretched on the seat. Swiftly, out came the Blackberrys, and the frenzied texting. Beanie, sitting in front of me, then called to his mate……

`Heard that Stevie has gone to America?…Going to college`?

`Yeah, Loser couldn`t take the pressure of rolling with us, innit` said gold chains.

`Pussy`

That was it. A 30 second conversation. Beanie started playing some R`nB crap, trying (and failing) to nod in time to it. (He obviously hadn`t heard of Boris` pledge to curb anti-social behaviour on buses….and how on earth can you not be in time to R`nB?….BOOM,boom,boom,BOOM,boom,boom,BOOM…its not freeform jazz, for gods sake)

I sat there, stunned.I had watched them, dull-eyed and slack-jawed. These two were not joking…they really meant what they said. They sneered. In their world, going to college in America (OK, probably not Harvard), is seen as running away, deserving of mockery, that being a big nobody on a sink estate in South London is somehow better, more preferable.

Its not just they`re stupid….not even that they don`t realise the the level of their stupidity. Its the apparent pride in their stupidity that gets me.

And these morons will breed. With other morons. (I say that on the basic presumption that anyone with any intelligence won`t go near them). And their kids will probably end up even bigger morons. Morons who regard anyone who can complete the Sun crossword as an intellectual.

You can`t have opened a newspaper, or watched the news in the last few days without hearing of the Care Quality Comission`s report, and the subsequent furore over the care (or abuse) of the elderly. As seems commonplace thses days, the report and the media coverage are somewhat different, although it does raise some interesting questions. Its significant, I think, is that a report ordered by Andrew Lansley was released just in time for his Health and Social Care Bill to be voted for in the House of Lords. I also find it somewhat suspicious that, to quote the report, `We had forecast that 10-20 % of hospitals could be non-compliant (20% were), and that a further 30-40% would show evidence of concerns (35% did), based on findings from our first set of inspections. Overall, 55% of hospitals were either non-compliant or gave cause for concern, against a forecast of 40-60%.` So…they found exactly what they were expecting to find. I make no further comment.

According to the report, only two wards in each hospital were inspected, only during the day, and with just one lunchtime. Yet one of the wards in two hospitals was considered `of major concern`. If that is so at mid-day, what was the care like when the day staff went home or at the weekend? Also, why did two wards in the same unit vary so much?

The biggest question of all though, is, are nurses becoming less caring, more abusive to the patients in their care?

Its important, I think, to distinguish between neglect by omission, and neglect by commission. Nurses aren`t deliberately abusing their patients (commission), but in some cases are neglecting by omission, for one simple reason, something that was mentioned in the report over and over……`‘Sometimes I am the only staff member to feed on the ward.`….“Staff were trying to help patients sit up and serve lunch, whilst a medication round was being carried out at the same time.”….“All the ward staff we spoke to on the stroke unit said they felt the unit was understaffed and the current levels were not appropriate to meet the needs of the patients.”

Indeed, one of the conclusions of the report was….`A lack of time to deliver care (due to short staffing, persistent high demand or excessive bureaucracy) can prevent staff from making sure that people’s needs are assessed and they are given the right support to eat.`

It is noteworthy that figures show the average ‘care of the elderly’ ward has just one nurse for 11 patients. Often you see comments in the media `My dad waited 3 hours for pain relief while nurses sat around the station gossiping and reading Heat magazine” . What these commenters don`t realise is that these `nurses` aren`t nurses at all…they`re physio, ward clerks or Occupational Therapists etc, and can`t help. Couple this with untrained, `care providers`, (who although willing, are sometimes just cowboys) and you have something that (like my old Austin Healey) looks good, but is going nowhere.

As for nutrition, there`s a couple of things I have noticed myself, both as a staff member, and as an in-patient. Quite often, the nurses only have a certain time to manage mealtimes. Food gets delivered, and a short time later, the porters have arrived to take the plates, containers and trays back to the kitchen. This gives the nurses limited time to get all the food out, ensure that its eaten ( and recorded that its been given and eaten) and return all trays back. Now, I spent a couple of years as a volunteer at both my local hospital, and the local old people`s home…and I know from experience that sometimes, assisting just one patient can take almost an hour…time that an overworked nurse cannot afford to take, no matter how much he/she might want to.

Secondly, many hospital trusts (mine included) has `protected mealtimes`. This evidently, is to `allow patients toeat their meals without disruption`. Truthfully, I can sometimes understand this, since some relatives can be a royal pain. I remember a friend of mine once complaining of supporting an elderly woman to eat as her two daughters sat there watching, while being acutely aware of the woman two beds down not eating at all…, but, on the whole…Why? Why NOT suggest that patients who need support with mealtimes have their relatives allowed in? (Also interesting to note, when Dr. Peter Carters comments saying the same thing in the Mail were printed, most of the comments were…`Its the nurse`s job`. Needless to say, these were the same commenters who moaned that `the nurses were sitting around, blah blah blah`)

On a smaller scale (I`ve only seen 4 consultants ever do it, tbh…but 4 is 4 too many, imo)… Consultants who INSIST on doing their ward rounds at mealtimes. Why? Why did they HAVE to do it then? Limited nurses trying to manage 20 – 30+ patients at lunch time…PLUS a drug round, with the usual suspects interrupting that, hence tabards…and the Consultant sweeps in….

Dame Joan Bakewell was quoted as saying that nurses needed lessons in empathy, which TOTALLY misses the point. Firstly, I am of the firm belief that nurses enter the profession for vocational reasons. But caring and empathy will only get you so far without resources (qualified staff and time both being resources). Secondly…how on earth do you teach `empathy`? You can be taught standards, practices etc…but you can`t be taught to care.

Nevertheless…there ARE occasionally some bad and/or lazy nurses, who deserve to be weeded out. At one hospital, the fact `that people in need of intravenous fluids did not have infusions` is inexcusable.

Having said all that…there ARE real problems in the NHS, which have to be acknowledged, and dealt with.

The problems started, I think, with Roy Griffiths. He was the author of the `Griffiths Report`, which ushered in General Managers. His report contained the famous phrase “If Florence Nightingale were carrying her lamp through the corridors of the NHS today she would almost certainly be searching for the people in charge.” At the time, there was great resistance to the report, Doctors and nurses feared their professions would lose influence after the dissolution of the consensus management teams that had run the NHS until then…and they were right, tbh. But after the Government `accepted the proposals`, Regional Health Authorities had four months to appoint their own general managers, then embark on District Health Authority appointments. Districts had until the end of 1985 to find unit general managers. The Department of Health began recruiting a national general manager. Mr Griffiths said this should be someone “almost certainly” from outside the NHS and civil service, with experience of effecting change in a large organisation.

Griffiths had envisaged a major role for doctors in general management, but with the advent of the internal market in the early 1990s, chief executives became legally responsible for balancing the books, which was a major factor in frustrating Griffiths’ vision of doctors in management.“In 1992, Roy Griffiths said: ‘I have a genuine horror that managers in the various professions will go down parallel routes barely touching each other and with very different objectives’. In many instances that is exactly what’s happened. It is ironic and sad that should be the case.”In fact general management’s biggest weakness is widely perceived to be the way it alienated staff from managers. Governments have used thinly veiled threats to make managers conform, usually to unpopular policies. Management have often intruded into clinical issues while overlooking basics – such as cleanliness – that the `old-style` managers rigidly adhered to.

After Griffiths, of course, came other re-organisations, initiatives, and, of course `Competition`, `Choice` and `Change`…and more and more committee`s, boards, directors and the like. It wasn`t THAT long ago that the Health Authority I was with appointed a `Director of Change`…along with staff. The decoration, carpetting and furnishing of her office came to over £20,000, yet soon after we had to close 4 SCBU beds…we couldn`t afford the staff. There ARE problems in the NHS, and those problems need fixing, now and not later. BUT, I don`t think this bill..or the direction the NHS is taking, will solve anything. Privatising parts of thr NHS will make a select few quite a lot of money, but one thing it won`t do is improve standards.Having (albeit well-intentioned) untrained staff with fancy titles won`t help the situation…and, since it will then require clipboard carrying `inspectors` to ensure quality will just increase cost.I fear that the NHS is on its last legs, to be honest. In a few years, it will be part of `Global-MediCare Inc`…and it will all be too late. Maybe I`m just getting more cynical…but I expect a slew of stories in the media of how bad the NHS is in the next few days, though.

Which leads me to a question…and one I have no answer to….Just WHY do we always look at the US model of healthcare for direction..and nowhere else?

I read about Herbert Chavez earlier. He`s the guy from the Philippines who has spent a fortune, and 15 years, having cosmetic surgery to transform himself into Superman. Now, he may be considered a bit of a nut, but its his money, and he`s hurting no-one. I`ve read of, and seen, people who have transformed themselves into tigers, leopards, lions and snakes. I once took a call from a guy who wanted surgery to change himself into an elephant, of all things… But they are the extreme fringes of cosmetic surgery.

After I left the NHS, I spent 7 years in cosmetic surgery. I`d already spent a couple of years in Burns & Plastics, ie reconstructive surgery, but this was pure cosmetic….and to be honest, I came to hate the job…with a passion.. Don`t get me wrong, there`s nothing wrong with cosmetic surgery per se, I think that most people, no matter their personality, have a deep desire to look and feel beautiful and attractive. We look into the mirror at night, we notice and sigh at all the little imperfections of our face, body, skin and hair. This desire to look better and younger is understandable, but….. I admit that it’s mainly to do with me. I loved what I did in the NHS…as I said before, it defined me…and helping people look a bit better didn`t do it for me, I`m afraid.

At first, it was fine. We did breast augmentations, liposuctions, noses, face lifts and tummy tucks, with breast augmentations being far and away the most common. But over and over, I kept hearing the same reason…`to give them confidence`. I sometimes wondered if there wasn`t an easier, and indeed cheaper, way to gain confidence…but there again, I`m not a woman, I have no real comprehension of how important it is to them. So far, so good.

but then…..

I can pinpoint the day that cosmetic surgery and I began to part company. A man in his late 30`s came in. He`d paid over £2000 to have his ear-lobes made slightly smaller. He was a salesman, and he felt that slightly smaller ear lobes would help him be a better salesman…because it `would give him more confidence`…..Then came chin implants, belly button inversions and labiaplasties.

Now, in the report Requests for Genetic Genitoplasty: How Should Healthcare Providers Respond? (2007), the authors, Lih Mei Liao and Sarah M. Creighton, reported that “the patients consistently wanted their vulvas to be flat, . . . some women brought along images to illustrate the desired appearance, usually from adverts or pornography that may have been digitally altered.” The critical conclusion of the report was that the designer vagina craze originated from the commercialism of sexual medicalisation.

This is where I start to worry. It really annoys me that, as a society, we`ve bocome so shallow that a persons worth, success and value are now measured by their looks, their hair, the clothes they wear. I mean…anal bleaching, toe-shortening, eyebrow transplants and knee lifts…..are they really necessary? There have been reports which suggest that 4 out of 5 of the first time patients who visited a plastic surgery clinic for consultation or surgery were high-intensity viewers of `Reality TV` shows on cosmetic surgery.They also revealed that their decision to go under the knife was largely influenced by `success` stories featured on programmes like `Extreme Makeover` and `The Swan`. Admittedly, these shows are american imports, but the format is universal. They usually show ordinary people, leading ordinary lives, who have become virtual social outcasts. By the end of the programme, they have become attractive, desirable and have gained instant popularity. This, of course, then increases social acceptability for surgery which has now considered `normal`, as commonplace as having your hair cut…and that then is bolstered by celebrities endorsing surgery. The problem with these shows, though, is the emphasis is always on the personal aspirations and success stories of the patients rather than on the effects and side effects of surgical procedures. Which means that surgeons usually have to warn against this make-believe world of unrealistic expectations where patients walk into a clinic demanding services which will give them instant gain, and no pain.

More and more, we are living in a quick-fix culture, a society where `beautiful` means `successful`, a society that demands instant gratification and promotes cosmetic surgery as an acceptable solution to perceived physical “inadequacies”. It is worrying that new research has revealed that a quarter of British women aged between 18 and 30, first considered cosmetic surgery between the ages of ten and 15.

Add to that there seems to be a rise in media propaganda, usually fronted by some teen idol or other, who talks of how he/she `felt bad about themselves/their body/their looks`. The shallow media imagery that portrays celebrity plastic surgery as the height of beauty is very convincing to teenagers who perceive themselves as “not pretty or handsome enough” . When Lady Gaga gives an interview to magazines in which she talks about her own physical insecurities and says she is open to plastic surgery as a solution to those insecurities, it makes a huge impression on her audience…mainly teenage girls. A research study performed by GoodSurgeonGuide showed that, of 1,012 girls interviewed, 41 percent of girls between the ages of 13-16 years old are already considering a cosmetic procedure. 62% said they wanted bigger breasts, 55% wanted to change their teeth and 49% wanted some form of surgery for weight loss. Around 33% also thought that some nose work would be good too. Some of these teens, 49%, wanted to have the procedure now and 7% had already had some plastic surgery done. Twenty-five percent of the girls said that they would change their appearance so that they would no longer be bullied about it at school.

Unrealistic expectations are hard to combat, though. It is SO important for patients to accept that having a nose like Brad Pitt won`t make you Brad Pitt…but patients don`t always listen. Consider Laura Pillarella. She had hoped that the procedures to remove the bags under her eyes and insert a chin implant would improve not only her looks, but also her life. They didn’t. ‘When the bandages came off, I was disappointed,’ she says. ‘I wasn’t ­beautiful — just different. It wasn’t enough.’ So Laura planned another operation … and then another. For the next ­decade she became trapped in a vicious cycle of surgery, dissatisfaction and more surgery. After 15 procedures, and ­spending more than £40,000 ­trying to be ­beautiful, she contemplated suicide. Or Colin Phillips. In 2009, an inquest in Cardiff heard how he hanged himself in a wood, distraught at how his third facelift had gone. One study reported a 3x higher rate of self-destructive acts, such as binge-drinking, drug ­overdoses and reckless driving following cosmetic surgery. Admittedly, these are the exceptions. Most surgeons now use psychological assessments before surgery, which has reduced similar instances. To save money, some people still find their surgeon on the internet, though…and cosmetic surgery is often cheap in Europe…..

Despite the economic crisis, cosmetic surgery is surprisingly still on the rise, although `quick fix` injectable fillers and for non-surgical methods to tighten loose skin of the jowls and neck has dropped, and surgical interventions have risen. I`m presuming that patients want more `bang for their buck`, for treatments which deliver a reliable, long-lasting result….which just goes to show…something.

I`ve seen some incredible work done by some truly gifted surgeons…and like I said, I`ve got nothing against cosmetic surgery…but I would advise that people do their research…ensure that their surgeon is registered with BAAPS (The British Association of Aesthetic Plastic Surgeons), and don`t get distracted by BOGOF offers….

Full disclosure here: I’ve had plastic surgery. It was on my upper eyelids…and only because they had sagged to such a degree that most of my eyes were permanently covered. But it did nothing for my self-esteem, my insecurities, or the fact that time was still going to relentlessly march across my face, body and hairline. I can`t fight Time…and there`s no way I`m going to have Abdominal Etching, or Bicep implants, or..a Penis Enlargement (no matter how much Mrs. Sabrewulfe begs :) )